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Information for Patients - About PK

Your goals and expectations are different from other surgical patients.

PK anesthesia will help you achieve your surgical goals.

Your anesthesia is the very safest it can be.

PK anesthesia is 21st century anesthesia care.

If you’ve made it to this page, you may be thinking about having cosmetic surgery. Or maybe you’ve have had some surgery in the past, and had issues or concerns with your previous anesthetic experience.

If that’s not the case, perhaps you’ve had a friend or relative who has had a less than pleasant experience with anesthesia that is causing you concern as you consider having your own cosmetic surgery.

PK anesthesia is ultra-safe and ultra-comfortable.

Once patients have experienced PK anesthesia, general anesthesia is no longer a consideration.

Waking up issues

With the ability to know your body has enough oxygen (pulse oximetry) with every beat of your heart, the anesthesia issues from the 1980s are far behind us.

When patients ask about this issue, I ask if they came to the surgeon’s office to have their surgery in a car. The answer is typically, ‘yes.’

The follow-up is, ‘You have already taken a far greater risk to your life by getting in a car than by having your anesthesia monitored with a pulse oximeter.

I assure you that you will wake up from your anesthesia with your same personality, sense of humor and memories intact. You just won’t remember your surgery.’

Control issues

Many patients have expressed concerns about ‘giving up control’ when they ‘go under’ anesthesia.’ This was a very legitimate concern, especially in the days prior to 1996. Now we have the technology to directly measure your brain’s response to anesthesia.

These devices are called brain activity monitors or brain monitors. In 1997, Dr. Friedberg added brain activity monitoring to PK anesthesia. This monitor functionally puts you back ‘in control’ of the dosing even while you sleep through your surgery.

How is this possible?

Before brain monitoring, we were forced by what we believed were indirect signs* of your brain’s response to anesthesia drugs to routinely over medicate you for fear of under medicating.

Routine over medication was the standard of practice before 1996. Unfortunately, it still is for many anesthesia providers.

With over medication not infrequently came a ‘hangover’ (or 'prolonged emergence' in the special language that doctors speak).

*Signs like heart rate and blood pressure changes are now known to be inaccurate reflections of your brain’s activity.

With brain monitoring, we directly measure your individual response to anesthesia. No longer is dosing based on ‘one size fits most.’

PK anesthesia is state of the art, custom tailored 21st century care for every individual patient’s specific needs at the time of their surgery.

By dosing medication in response to your individual needs, you don’t get ‘too much,’ ‘too little,’ but ‘just right’ (like Goldilocks) is the amount of anesthesia you will get.

Your brain really is ‘in control’ even though you’re asleep through your surgery.

Can you explain how the brain monitor works for me in words the average person can unerstand?

The brain monitor can show 2 lines of information.

The top line shows how your brain is responding to the sleep medication.

This information is delayed from 'real time' by 15-30 seconds.

However, the lower trace is a real time display of the muscle between your eyebrows (EMG).

Activity on this display tells me that something above your neck is happening, even if you only move a litle bit.

During sedation, the meaning of movement (and what to do about) had been the philosophical problem that has plagued anesthesia providers (i.e. anesthesiologists and nurse anesthetists alike) and surgeons for many years before brain monitors existed.

Traditionally, the surgeon would say, "the patient is 'too light,' only to get an anesthesia provider response of 'put some more local in.' "

This exchange would set the stage for a circular argument not unlike the beer commercial in which the actors argued 'tastes great,' no 'less filing,' without a resolution.

The use of the brain monitor with propofol in the range of 60-75% of awake value with the EMG as a second trace, as I advocate, is a legitimate, physician directed off-label use of the brain monitor.

When your brain activity shows 'asleep,' if you move a little bit, a 'spike' in the EMG occurs.

Although you are still asleep, the brain monitor helps the surgeon know to inject more local anesthesia long before you would be able say, 'ouch.'

Your anesthesia provider will also know to give a little more propofol at the same time.

Using the brain monitor in this fashion keeps you from hurting at the beginning of your surgery as well as during your surgery.

When your surgery is finished and your propofol is turned off, you awaken quickly, yet with very little discomfort because of the manner in which your surgery and anesthesia was performed.

To protect yourself, you must be your own patient advocate.

Ask if you will have your brain directly monitored during your surgery.

If you are not satisfied with the answer, you are unlikely to change the belief of the surgeon, faciilty administrator or anesthesia provider who gives the answer to you.

Simply tell them you will have to find a different facility where this monitoring is used.

Please remember 'belief' systems are not rational.

You cannot talk a person out of their belief system.

You can only hope to modify their behavior.

Nausea and vomiting after surgery (PONV)

The secret to preventing this problem comes in two parts:

First, don’t hurt the patient on the operating table.

Pain can make you sick to your stomach.

Second, don't give drugs that make people sick to their stomach

'Stinky gases' like isoflurane, sevoflurane or IV narcotics like fentanyl.

It may come a surprise to you, but anesthesiologists actually had to do a study to learn that vomiting was the #1 issue you most wanted to avoid after surgery.

Gagging on the breathing tube was 2nd, nausea 3rd, and pain 4th.

Ten years after the study, a whole chapter was finally dedicated to PONV for the first time in anesthesia's #1 respected, referenced textbook, MiIler's Anesthesia, 7th ed.

Lest you think the anesthesia profession finally understood the importance of PONV to you, PONV received the 'stepchild' treatment by getting positioned #86 of 102 chapters.

PK anesthesia solved the PONV problem more than 15 years ago.

This web site has been promoting that solution for 8 years on the internet.

The good news about the Miller chapter is that it was written by Dr. Christian Apfel, the world's foremeost PONV authority, .

He wrote that PK anesthesia was a non-PONV technique, a historic endorsement for PK anesthesia.